Missouri: how to sign your advance directive

What Missouri asks

What you need to sign in Missouri

Instruments

Two, in separate chapters — a declaration (ch. 459) stating your wishes, and a durable power of attorney for health care (§§404.800–404.865) appointing your agent

Form

Declaration illustrative — §459.015(3): "it shall not be necessary to use this sample form." No form section appears among §§404.800–404.872, so the health care power of attorney has none

Execution

Power of attorney: notarial acknowledgment only — no witness route. Denominating it a "Durable Power of Attorney", carrying the prescribed notice sentence, and "subscribed ... and dated and acknowledged in the manner prescribed by law for conveyances of real estate" (§404.705(1) via §404.810). Declaration: two or more witnesses at least 18 — but only if the declaration is not wholly in your handwriting (§459.015(1)(4))

May not witness

Power of attorney: nobody — there are no witnesses. Declaration: the person who signed on your behalf and at your direction may not witness; the witnesses must be at least 18 (§459.015(1)(4))

May not be your agent

Your attending physician or their employee, or an owner, operator or employee of a health care facility in which you are a resident — unless you and the attorney in fact are related by affinity or consanguinity within the second degree, or are members of the same religious community (§404.815)

Copy rule

The copy is the thing that must be filed. §404.840(1) requires "a copy of a power of attorney for health care decisions" to be made part of the patient's medical record

Delivery

Yes — a precondition. The copy must be in the record when the power of attorney becomes known to the provider "and prior to the provider's taking any action pursuant to the decision of the attorney in fact" (§404.840(1)). Power-of-attorney side only — the declaration side's §459.025 "Declaration operative, when" is index-only in the corpus and unread, so this row claims nothing about the declaration

Registry

Yes — the Advance Health Care Directives Registry (§459.250). The Department of Health and Senior Services contracts a third party to run a secure online central registry. Documents are submitted electronically at an intake point — a licensed health care provider or a licensed attorney — signed electronically with a unique identifier, for a fee of no more than $10. "Failure to register a document with the registry ... shall not affect the document's validity" (§459.250(9))

Age

18 — witnesses must be at least 18 (§459.015(1)(4)), and "adult" means 18 or older (§459.250(1)(1))

Revocation

Any manner that communicates the intent. A power of attorney for health care may be revoked "at any time and in any manner by which the patient is able to communicate the intent to revoke", effective "upon communication of such revocation by the patient to the attorney in fact or to the attending physician or health care provider" (§404.850(1)). A later valid power of attorney revokes any prior one unless it provides otherwise (§404.850(3)). No divorce provision appears in the captured sections of ch. 404 — §404.710, §404.714 and §404.717 are incorporated by §404.810 and are not in the corpus

Oral instructions

Both instruments are written — §459.015(1)(1); §404.705(1). Revocation is not: §404.850(1) allows it "in any manner by which the patient is able to communicate the intent to revoke."

Provider may not require

§404.835(1) — it is unlawful for a physician, nurse or other health care provider, or an employee of a health care facility, to require you to execute a durable power of attorney for health care as a condition of care or admission. §404.835(2) applies the same rule to insurers and health plans

Artificial nutrition and hydration

Specific authority required. §404.820(1): if you want your attorney in fact to be able to direct the withholding or withdrawal of artificially supplied nutrition and hydration, you "shall specifically grant such authority in the power of attorney." No attorney in fact may, with intent to cause death, authorise withdrawal of nutrition or hydration the patient can take by natural means (§404.820(2))

Carried device

Nothing for the directive — and see below

Citation

Mo. Rev. Stat. §404.800 et seq. · §459.015 et seq.

Read from the enacted statute, 2026-09-18.